Discussion
According to WCC professionals parental worries about childhood fever are the major driving factor behind most fever-related contacts with the WCC. Four subcategories were identified as possible drivers of parental worries: level of knowledge, level of experience, influence of educational level and social network, and perceived inconsistency in paracetamol administration advice among healthcare professionals. In addition, WCC professionals believe that current information provision on fever is limited and focuses mainly on fever as a side-effect of vaccination jabs. WCC professionals subsequently expressed the need to improve current information provision and provided starting points in terms of its findability, language, lay-out, content and timing. It was especially mentioned that the content of information provided should become more consistent among different healthcare providers to avoid worries caused by uncertainty. The timing of information provision was under debate but leaned towards the first two months of a child’s life.
According to WCC professional parents often seem to overestimate the significance of body temperature and perceive that the degree of fever indicates the severity of the underlying illness. This finding is in accordance with previous research that parental worries may arise because of the belief that fever is a disease and not just a symptom of illness. Subsequently, when parents view fever as a disease on its own, this will ultimately lead to misconceptions about its role in illness [
4,
5]. It is also demonstrated that parental worries lead to the increased use of healthcare services [
1,
2,
38].
Corresponding with earlier research, WCC professionals perceived they received most questions from first-time parents, with younger children causing more worries, because those parents lack own experience of coping with fever. As a consequence, parents consult a GP more often for a firstborn child than for a second or subsequent child [
39,
40]. Our study also confirms that parents feel uncertain about their actions during fever episodes and consult WCC professionals regularly for advice [
4,
10,
21,
40‐
44].
In line with previous research WCC professionals stated that the social network is an important source of information for parents [
10,
40,
45]. WCC professionals experienced that higher-educated parents worry more quickly and tend to rely more on advice of healthcare providers and the Internet than lower-educated parents. It is known from the literature that healthcare professionals and the Internet are an important source of information for parents [
4,
10,
40,
43,
45]. Previous research also showed that the Internet is mostly used as information source by younger parents and children [
10]. WCC professionals explained the difference between higher and lower educated parents in relying on healthcare professionals by the observation that higher-educated parents seem to have a smaller social network in close proximity to rely on for advice. This observation is in accordance with previous research which demonstrated that parents who did not graduate from high school were less likely to consult a healthcare professional and depended more on nonmedical individuals for advice. However, a lower educational level was also associated with practices that could delay care [
15,
46,
47]. Differences among lower and higher educated parents in relying on the social network and healthcare professionals as important information sources should be considered when developing information provision about childhood fever.
Other explanations of why higher educated parents tend to rely more on healthcare providers may lie within the fact that education enhances parents’ knowledge of fever, healthcare facilities and may improve their capability to communicate with healthcare providers [
48]. Also, it may be possible that parents with a low income may tend to wait longer to avoid medical expenditures [
49]. It was perceived that inconsistency in received advice, due to the use of different guidelines by WCC professionals, GPs, GPs, medical specialists, and chemists, led to confusion, more uncertainty and worries during fever episodes. Previous research already indicated that practice variations exist in treating febrile infants among pediatric emergency physicians [
50]. Different studies also showed that providing conflicting information on fever management increases worries among participants, especially when the information comes from sources considered reliable and trustworthy, such as a healthcare professional [
12]. Like recent qualitative research among parents presenting to GP out-of-hours services with a febrile child, WCC professionals recommended providing consistent information among different healthcare providers [
51].
WCC professionals perceive that the information currently available on fever is very limited, differs across healthcare providers and does not focus on fever as a separate topic but mainly on fever as a possible side-effect of vaccination jabs. In addition, they stated that current information provision on fever needs improvement. Previous research indicates that educational interventions seem to be most effective when they are provided in personal discussions to tailor information to needs, beliefs, experience, and skills, of end-users. In addition, information resources should be accurate, consistent, written, simple to use, and contain simple symbols, [
9,
41,
52,
53]. According to Cabral et al [
54] interventions may be more effective if they focus on reducing uncertainty in situations when a consultation or antibiotic prescription is needed by increasing knowledge among parents and clinicians about which symptoms need medical attention.
This is the first qualitative study to explore the experiences of WCC professionals towards childhood fever and current information provision, to inform future interventions aimed at educating parents prior to their child’s first fever episode. A strength of our study is the inclusion of WCC professionals working at different WCC locations in the region of Maastricht (the Netherlands), thereby including neighbourhoods with a variety of socioeconomic statuses. We achieved methodological and investigator triangulation, held peer debriefings with the wider research team and a member check.
Dutch WCC has specially trained doctors and nurses in preventive youth healthcare, while GPs have a gatekeeping role and mostly focus on curative youth healthcare. The tasks of Dutch WCCs do resemble the tasks of other preventive healthcare services worldwide We believe that our findings regarding information provision about childhood fever may be transferable to other countries as well.
We purposefully sampled WCC professionals from a small and deprived region in the Netherlands with a limited diversity in ethnicities. It is therefore possible that the views and experiences may differ from WCC professionals in other regions. It is important to keep in mind that the WCC professionals expressed their thoughts about possible drivers of fever-related contacts in parents and we did not investigate the experiences of parents themselves.